眼瘢痕性类天疱疮病例的回顾性分析

Retrospective analysis of ocular cicatricial pemphigoid

目的探讨眼瘢痕性类天疱疮（OCP）的临床特点。方法回顾性系列病例研究。回顾2005年1月至2008年10月于北京大学第一医院眼科和皮肤科联合确诊为OCP的系列病例5例（10只眼）患者的病史、眼科常规检查、结膜囊细菌培养及全身免疫学常规检查的结果，分析其误诊原因。结果确诊前，5例患者在早期均误诊为慢性结膜炎，在这些病例瘢痕较明显时，1例曾被误诊为Stevens-Johnson综合征，1例误诊为干燥综合征，患者从首次就诊至确诊的时间长达2～5年。在确诊前均经过长期抗菌滴眼液的局部治疗，1例经3次内翻倒睫矫正术，术后病情加重。5例患者中诊断为OCPⅡ期3只眼、Ⅲ期5只眼、Ⅳ期2只眼，3例患者结膜囊细菌培养阳性，仅1例患者肿瘤标记物铁蛋白轻度升高，其余患者常规免疫学检查均正常。确诊后经合理治疗病情控制，但2例患者结膜瘢痕继续进展。结论OCP早期表现类似慢性结膜炎，提高对OCP的警惕和认识是避免误诊的重要手段。

Objective To analyze the clinical characterization of ocular cicatricial pemphigoid （OCP）. Methods It was a retrospective series case study. Five consecutive patients referred for the evaluation of possible OCP from January 2005 to October 2008 in Departments of Ophthalmology and Dermatology of Peking University First Hospital. History and clinical characterization of 5 cases （10 eyes） OCP having been misdiagnosed were analyzed to find the causes of misdiagnosis. Results All of cases were diagnosed as chronic conjunctivitis during the early stages of the diseases, one case was diagnosed as Stevens-Johnson syndrome and one as Sjogren syndrome during the later stage. It was two to five years from the first time to see a doctor to definite diagnosis. All of cases have been prescribed antibiotic eye drops for a long times, one case has been undergone three times trichiasis operation and made the disease progression. Among the five patients with OCP, 3 eyes were diagnosed Stage Ⅱ , 5 eyes Stage Ⅲ,2 eyes Stage Ⅳ. Three cases were positive of bacterial culture. Only in 1 case, there was slight increase of iron protein as tumor mark. Inflammation was controlled by the end of the study, but cicatrization of 2 cases still progressed. Conclusion Manifestation of OCP can mimic chronic conjunctivitis during the early stages, it is important to pay high attention to OCP, misdiagnosis may be stopped.